The DHS 3038 form serves as a critical instrument under the Interstate Compact for Juveniles, a vital legal framework facilitating the supervision and support of juveniles on parole or probation across state boundaries. It embodies a step towards safeguarding the welfare of juveniles requiring oversight beyond their home state's jurisdiction, enabling them to reside with parents or legal guardians or for other substantiated reasons in a receiving state. This meticulously structured document necessitates comprehensive input covering the juvenile's identifying information, legal status, supervisory details, and the rationale behind the requested interstate movement. Furthermore, the form mandates the inclusion of a plethora of supporting documents such as legal history, school records, and health information to furnish a holistic view of the juvenile's circumstances. The DHS 3038 underscores a collaborative approach between states to ensure continuity of care and supervision, adhering to the laws that govern juvenile parole or probation. The procedural guidelines it sets forth ensure that such requests are executed with precision, safeguarding the rights and futures of the young individuals in question. The overarching goal of this framework is to cultivate an environment conducive to their rehabilitation and positive development, irrespective of state lines.
| Question | Answer |
|---|---|
| Form Name | Form Dhs 3038 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | FIA3038_43096_7 arizona probation interstate compact form |
INTERSTATE COMPACT FOR JUVENILES
PAROLE OR PROBATION INVESTIGATION REQUEST
Michigan Department of Human Services
FORM IV
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(Receiving State) |
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(Sending State) |
Name of Juvenile:
Status: |
Parole |
To reside with: OR
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DOB: |
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Race: |
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Sex: |
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Probation |
Sending State File # |
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Is residing with: |
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(Name) |
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Relationship: |
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Telephone: ( |
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Address: |
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City/State: |
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Zip: |
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Reason for Adjudication/Commitment: |
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Date of Adjudication: |
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Date of Commitment: |
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Minimum Parole/Probation |
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Maximum Parole/Probation |
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Expiration Date: |
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Expiration Date: |
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Anticipated Placement Date: |
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Present Location: |
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We desire to transfer this juvenile on |
parole |
probation to your state: |
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Because his/her parent/legal guardian resides in your state.
For the following reasons, with your consent:
Other Comments:
THE FOLLOWING MATERIALS ARE ENCLOSED:
Cover letter
IA/VI Application for Compact Services and Memorandum of Understanding and Waiver
Petition(s)
Order of Adjudication and Disposition
Legal and Social History
Parole/Probation Conditions (Agreement)
School Transcript/Records
Immunization Records
Any other Pertinent Information
Referred by:
(Name – Please Print)
FOR ICJ USE ONLY
Signed:
(Compact Official/Designee)
Title:
Referring Agency:
AUTHORITY: Public Act 56, 2003
COMPLETION: Required.
PENALTY: Juvenile may not be returned.
Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.
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DISTRIBUTION: Original – Receiving State Local Office |
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(ICJ FORM IV) |
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Copy – Receiving State Compact Office |
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Copy – Michigan Compact Office |
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Copy – Local DHS Office |
INSTRUCTIONS FOR COMPLETING ICJ FORM IV
PLEASE TYPE OR PRINT LEGIBLY:
ALL MATERIALS MUST BE PROVIDED TO THE SENDING STATE’S INTERSTATE COMPACT FOR JUVENILES OFFICE IN TRIPLICATE, AND MUST BE DIVIDED INTO THREE SEPARATE, COMPLETE, AND IDENTICAL PACKETS FOR FORWARDING.
Receiving state: state in which juvenile is residing or will reside.
Sending state: state of probation/parole/adjudication; requesting state.
Juvenile name, etc.: insert juvenile’s name and vital information as indicated.
Status of juvenile: parole, probation or other; if other, please explain in space provided.
Sending state file #: the case number given in your office to the juvenile’s file or case.
To reside with/is residing with: check one and insert name of person(s) with whom juvenile will reside or does reside in the receiving state. Complete information regarding full address including phone number with area code, and relationship to the juvenile.
Reason for adjudication/commitment: fill in adjudication or pending offenses for which juvenile is to be supervised.
Date of adjudication: insert date of
Date of commitment: insert date of
Minimum parole/probation period: earliest date juvenile could be released from supervision.
Maximum Parole/probation period: latest date juvenile could be released from supervision.
Anticipated placement date: approximate date juvenile is anticipated to arrive in this proposed home.
Present location: insert current location of juvenile (at the time this request for supervision is being transmitted to the ICJ office).
(Why) we desire to transfer this juvenile. . .: if the juvenile’s parent or legal guardian resides in the state, check the appropriate box; if the juvenile will be living with someone other than parent or legal guardian, complete the “for the following reasons” section.
Check the appropriate boxes as to the enclosures that are being submitted with the referral packet. All applications should have a cover letter. Include at the very minimum: ICJ Forms IV and IA/VI, Petition/s, Order/s of Adjudication and Disposition, and Parole/Probation Conditions (Agreement). If a social history is available, it must be included as well. All other items are helpful to the successful investigation and supervision of this case by the proposed new state of residency.
Referred by: Printed name of caseworker or officer making this request for supervision.
Referring Agency: Print name of requester’s agency.
Signature: Form should be signed by an ICJ Compact Official or Designee.
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(ICJ FORM IV) |
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